Background
Impaired neurocognition and social cognition in schizophrenia
Impaired neurocognition and violence in schizophrenia
Impaired social cognition and violence in schizophrenia
Instrumental and reactive violence in schizophrenia
Paradigms for measuring violence in schizophrenia
Aims
Method
Study design
Participants and setting
Cognitive assessment
Functional performance
Symptom assessment
Assessment of violence risk and need for therapeutic security
Assessment of violence
Medication
Data analysis
ANOVA | Effect size | Receiver operating characteristic | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Non-violent n = 79 | Violent n = 10 | F-statistic (df 1,87) | P value | Partial Eta squared | 95 % CI | 95 % CI | |||||||
mean | S.D. | mean | S.D. | d | lower | upper | AUC | lower | upper | ||||
Age | 40.9 | 12.7 | 36.1 | 9.4 | 1.342 | 0.250 | - | 0.38 | −0.27 | 1.04 | 0.62 | 0.45 | 0.80 |
Length of stay (years) | 8.0 | 9.7 | 3.0 | 5.0 | 2.243 | 0.13 | - | 0.50 | −0.16 | 1.16 | 0.73 | 0.54 | 0.91 |
Chlorpromazine equivalents | 538 | 366 | 772 | 397 | 3.6 | 0.063 | - | 0.64 | −0.03 | 1.30 | 0.67 | 0.46 | 0.88 |
Pre-morbid IQ (TOPF-UK) | 96.0 | 12.6 | 96.8 | 8.1 | 0.023 | 0.879 | - | 0.06 | −0.72 | 0.84 | .49 | 0.31 | 0.67 |
PANSS total | 62.5 | 20.0 | 90.1 | 19.4 | 12.2 | 0.001 | .157 | 1.38 | 0.58 | 2.19 | 0.84 | 0.71 | 0.97 |
PANSS positive | 13.7 | 7.0 | 21.6 | 8.7 | 9.32 | 0.003 | .113 | 1.21 | 0.41 | 2.01 | 0.79 | 0.65 | 0.93 |
PANSS negative | 18.9 | 7.9 | 25.0 | 6.5 | 6.175 | 0.111 | .078 | 0.98 | 0.19 | 1.78 | 0.71 | 0.55 | 0.87 |
PANSS general | 29.02 | 10.3 | 43.6 | 10.4 | 14.202 | .000 | .163 | 1.49 | 0.68 | 2.31 | 0.86 | 0.73 | 0.99 |
HCR-20 total score | 20.8 | 5.7 | 28.2 | 8.0 | 14.04 | 0.000 | .142 | 1.26 | 0.57 | 1.94 | 0.78 | 0.59 | 0.96 |
HCR-20 Historical | 12.9 | 2.7 | 15.2 | 4.5 | 5.178 | .025 | .057 | 0.763 | 0.09 | 1.43 | 0.75 | 0.55 | 0.95 |
HCR-20 Current | 4.50 | 2.63 | 7.2 | 2.78 | 12.59 | .001 | .129 | 1.91 | 0.51 | 1.87 | 0.76 | 0.59 | 0.94 |
HCR-20 Risk | 3.39 | 2.12 | 5.80 | 2.29 | 10.06 | .002 | .106 | 1.064 | 0.39 | 1.74 | 0.77 | 0.62 | 0.71 |
SOFAS | 59.2 | 17.2 | 35.6 | 18.9 | 14.9 | 0.001 | - | 1.29 | 0.61 | 1.98 | 0.83 | 0.66 | 0.99 |
DUNDRUM-1 (11 item) | 29.54 | 5.01 | 27.40 | 7.1 | .994 | 0.322 | .012 | 0.334 | −0.33 | 0.99 | 0.44 | 0.21 | 0.66 |
DUNDRUM-1 (9 item) | 27.08 | 3.93 | 23.90 | 6.93 | 3.275 | 0.074 | .037 | 0.607 | −0.06 | 1.27 | 0.38 | 0.16 | 0.60 |
Results
MATRICS Domains and Composites | ANOVA | Effect Size d | Receiver operating characteristic | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Non-violent n = 79 | Violent n = 10 | F-statistic | P value | Partial Eta squared | d | 95 % CI | AUC | 95 % CI | |||||
Mean | S.D | mean | S.D | (df 1,87) | lower | upper | lower | upper | |||||
Processing Speed | 24.82 | 15.5 | 18.50 | 10.2 | 5.242 | 0.025 | 0.058 | 0.76 | 0.10 | 1.43 | 0.65 | 0.51 | 0.79 |
Attention | 28.4 | 11.1 | 23.8 | 10.4 | 2.43 | 0.122 | 0.028 | 0.52 | −0.13 | 1.18 | 0.62 | 0.43 | 0.81 |
Working Memory | 31.3 | 12.7 | 32.8 | 8.4 | 0.053 | 0.818 | 0.001 | 0.24 | −0.41 | 0.90 | 0.45 | 0.30 | 0.60 |
Verbal Learning | 33.9 | 7.6 | 28.4 | 4.5 | 7.56 | 0.007* | 0.082 | 0.92 | 0.25 | 1.59 | 0.72 | 0.58 | 0.86 |
Visual Learning | 32.7 | 12.6 | 26.5 | 11.9 | 2.57 | 0.11 | 0.029 | 0.53 | −0.12 | 1.20 | 0.64 | 0.46 | 0.82 |
Reasoning | 35.9 | 7.4 | 35 | 5.4 | 0.808 | 0.371 | 0.009 | 0.30 | −0.35 | 0.96 | 0.51 | 0.33 | 0.68 |
Social Cognition | 35.7 | 11.0 | 24.4 | 6.3 | 11.57 | 0.001* | 0.12 | 1.14 | 0.46 | 1.82 | 0.81 | 0.71 | 0.90 |
Neuro-cognitive composite | 31.1 | 9.3 | 27.5 | 6.7 | 3.05 | 0.084 | 0.035 | 0.58 | −0.07 | 1.24 | 0.61 | 0.45 | 0.76 |
MATRICS Total Composite | 20.9 | 14.0 | 12.8 | 9.1 | 5.720 | 0.019 | 0.063 | 0.80 | 0.13 | 1.47 | 0.67 | 0.53 | 0.81 |
Differences in cognitive ability between violent and nonviolent groups
Predicting violence
Correlations between cognition, real world functioning, violence risk and violence
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Social Cognition | - | ||||||||||
2 | Neuro-cognition Composite | 0.397 | - | |||||||||
.001 | ||||||||||||
89 | ||||||||||||
3 | MATRICS Composite (includes neuro-cognition and social cognition) | 0.541 | 0.984 | - | ||||||||
.001 | .001 | |||||||||||
89 | 89 | |||||||||||
4 | PANSS Total | −0.461 | −0.338 | −0.405 | - | |||||||
.001 | .003 | .001 | ||||||||||
77 | 77 | 77 | ||||||||||
5 | PANSS Positive | −0.361 | −0.149 | −0.217 | 0.773 | - | ||||||
.007 | .195 | .058 | .000 | |||||||||
77 | 77 | 77 | 77 | |||||||||
6 | PANSS Negative | −0.398 | −0.359 | −0.406 | 0.729 | 0.323 | - | |||||
.001 | .001 | .001 | .001 | .004 | ||||||||
77 | 77 | 77 | 77 | 77 | ||||||||
7 | PANSS General | −0.473 | −0.298 | −0.371 | 0.917 | 0.735 | 0.571 | - | ||||
.001 | .009 | .001 | .001 | .001 | .001 | |||||||
77 | 77 | 77 | 77 | 77 | 77 | |||||||
8 | HCR-20 Total In | −0.252 | −0.314 | −0.343 | −0.666 | 0.567 | 0.543 | 0.614 | - | |||
.017 | .003 | .001 | .001 | .001 | .001 | .001 | ||||||
89 | 89 | 89 | 77 | 77 | 77 | 77 | ||||||
9 | SOFAS | 0.411 | 0.521 | 0.556 | −0.617 | −0.438 | −0.499 | −0.542 | −0.616 | - | ||
.001 | .001 | .001 | .001 | .001 | .001 | .001 | .001 | |||||
86 | 86 | 86 | 77 | 77 | 77 | 77 | 86 | |||||
10 | History of Homicide or lethal violence D1 item 1 | 0.254 | −0.021 | 0.028 | −0.210 | −0.145 | −0.197 | −0.092 | −0.215 | 0.082 | - | |
.016 | .848 | .759 | .067 | .207 | .087 | .425 | .043 | .453 | ||||
89 | 89 | 89 | 77 | 77 | 77 | 77 | 89 | 86 | ||||
11 | Violence | −0.340 | −0.122 | −0.194 | 0.343 | 0.293 | 0.214 | 0.362 | 0.308 | −0.351 | −0.288 | - |
.001 | .255 | .069 | .002 | .010 | .062 | .001 | .003 | .001 | .006 | |||
89 | 89 | 89 | 77 | 77 | 77 | 77 | 89 | 86 | 89 |
Mediation between neurocognition, social cognition and violence
C1: Direct effect X on Y before mediation | C2: Direct effect X on Y after mediation | A: Mediated effect X on Y via M | B: Direct effect M on Y adjusted for X | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
M | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | ||||
lower | Upper | lower | Upper | lower | upper | Lower | upper | |||||
X = Neurocognitive composite | 0.929 | 0.850 | 1.016 | |||||||||
social cognition | 0.989 | 0.893 | 1.095 | 0.932 |
0.849
|
0.976
| 0.869 |
0.779
|
0.970
| |||
PANSS | 0.955 | 0.836 | 1.092 | 0.947 |
0.821
|
0.994
| 1.069 |
1.016
|
1.125
| |||
SOFAS | 1.008 | 0.904 | 1.124 | 0.916 |
0.788
|
0.997
| 0.931 |
0.882
|
0.982
| |||
HCR-20 | 0.972 | 0.881 | 1.072 | 0.950 |
0.831
|
0.997
| 1.214 |
1.058
|
1.393
| |||
X = social cognition | 0.864 |
0.781
|
0.957
| |||||||||
neurocognition | 0.869 |
0.779
|
0.970
| 0.997 | 0.934 | 1.031 | 0.989 | 0.893 | 1.095 | |||
PANSS | 0.886 |
0.774
|
0.986
| 0.958 | 0.791 | 1.034 | 1.054 | 0.997 | 1.114 | |||
SOFAS | 0.906 | 0.811 | 1.012 | 0.964 | 0.817 | 1.052 | 0.953 | 0.901 | 1.007 | |||
HCR-20 | 0.890 |
0.803
|
0.987
| 0.973 | 0.870 | 1.065 | 1.187 |
1.025
|
1.374
| |||
X = symptoms (PANSS total score) | 1.067 |
1.017
|
1.120
| |||||||||
neurocognition | 1.069 |
1.015
|
1.126
| 1.006 | 0.985 | 1.126 | 0.955 | 0.836 | 1.092 | |||
Social cognition | 1.054 | 0.997 | 1.114 | 1.029 | 0.995 | 1.107 | 0.886 | 0.774 | 1.014 | |||
SOFAS | 1.042 | 0.986 | 1.102 | 1.037 | 0.909 | 1.136 | 0.935 | 0.867 | 1.009 | |||
HCR-20 | 1.032 | 0.969 | 1.099 | 1.043 | 0.915 | 1.165 | 1.170 | 0.953 | 1.436 | |||
X = social function (SOFAS) | 0.931 |
0.887
|
0.978
| |||||||||
Neurocognition | 0.930 |
0.881
|
0.982
| 1.002 | 0.958 | 1.046 | 1.008 | 0.904 | 1.124 | |||
Social cognition | 0.953 | 0.901 | 1.007 | 0.973 | 0.913 | 1.005 | 0.906 | 0.811 | 1.012 | |||
PANSS | 0.935 | 0.867 | 1.009 | 0.972 | 0.866 | 1.092 | 1.042 | 0.986 | 2.633 | |||
HCR-20 | 0.971 | 0.920 | 1.024 | 0.942 | 0.753 | 1.008 | 1.320 |
1.095
|
1.614
| |||
X = violence proneness (HCR-20 total score) | 1.228 |
1.075
|
1.403
| |||||||||
Neurocognition | 1.214 |
1.058
|
1.393
| 1.012 | 0.956 | 1.085 | 0.972 | 0.881 | 1.072 | |||
Social cognition | 1.187 |
1.027
|
1.371
| 1.055 |
1.000
|
1.166
| 0.890 |
0.797
|
0.987
| |||
PANSS | 1.170 | 0.953 | 1.436 | 1.102 | 0.817 | 2.175 | 1.032 | 0.984 | 1.107 | |||
SOFAS | 1.320 |
1.088
|
1.601
| 1.058 | 0.759 | 1.392 | 0.971 | 0.917 | 1.022 |